Healthcare Provider Details

I. General information

NPI: 1366371247
Provider Name (Legal Business Name): ASHLEY TRAFFORD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 JENSEN GROVE DR STE 4
BLACKFOOT ID
83221-1636
US

IV. Provider business mailing address

725 JENSEN GROVE DR STE 4
BLACKFOOT ID
83221-1636
US

V. Phone/Fax

Practice location:
  • Phone: 208-274-4565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2771094
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: